With alarming numbers of heroin deaths in the state, officials are examining the possibility of equipping more first responders with a nasal spray to reverse lethal opiate overdoses.

State police say at least 185 people have died from suspected heroin overdoses in Massachusetts in the last four months. The number does not include overdose deaths in the state's three largest cities — Boston, Worcester and Springfield.

Although there are no comparable figures for overdose deaths in the same period last year, state police spokesman David Procopio says overdoses are on the rise.

Recognizing that overdoses from opioids, which includes heroin, oxycodone and morphine, pose a serious health threat, the state Department of Public Health launched the Opioid Overdose Education and Naloxone Distribution prevention program using intranasal Narcan (naloxone) in an attempt to reverse this alarming trend.

Naloxone is an opioid antagonist that displaces the opioid from receptors in the brain. An overdose occurs because the opioid is on the same receptor site in the brain that is responsible for breathing. Naloxone allows slowed breathing to resume.

Cheryl Bartlett, the state Board of Health commissioner, is a supporter of Narcan, which she said is safe.

"What Narcan does is reverse the effects of the drug and allows the person to recover from an overdose," Ms. Bartlett explained. "It's an amazing drug. It's a drug that has been around a long time. It's an effective tool."

In November 2007, the state Department of Public Health began its pilot OEND program with community-based distribution sites, including AIDS Project Worcester, followed by a first-responders program three years later.

Each Narcon kit, which includes two doses of naloxone and two atomizers, costs about $41.

With a bag of heroin cheaper than a pack a cigarettes or most six-packs of beer, and prescribed opiates available more in the community, Ms. Bartlett said the state is experiencing a spike in elicit drug use. As a result, there has been a lot discussion on what it would take to make Narcan more readily available in the state.

"Hopefully, we will move forward making recommendations to take steps to make Narcan easily available for everyone," she said.

Marc C. Restuccia, medical director for UMass Memorial Medical Center's LifeFlight program and Worcester EMS, said, "It's pretty striking when you have someone, for all intents and purposes, apparently dead and you give them the naloxone and they start breathing again and wake up. It does look pretty miraculous the first few times you see it."

Dr. Restuccia said all Advance Life Support ambulances and emergency departments in Massachusetts have been using naloxone for reversing opiate overdoses since the mid-1990s. The use of the naloxone nasal spray started seven years ago, but naloxone in the needle form is still used a fair amount, he said.

"Certainly, EMS should definitely have naloxone because they are obviously trained medical people and we do use it," Dr. Restuccia said. "The question that has come up recently — should first responders have it, police and fire — you'll find people who will argue on both sides of this. But from a public health standpoint, it certainly seems like a pretty decent idea."

While the state Department of Public Health recognized the urgency back in 2007, Ms. Bartlett said, she thinks the slow implementation of Narcan, on a statewide level, is due partly because there hasn't been a public outcry in many communities where the issue of heroin use and addiction often goes unspoken.

Because of the relatively rapid response time by EMS, Dr. Restuccia said there probably isn't a perception in Worcester that police need to be equipped with Narcan.

Worcester District Attorney Joseph D. Early Jr. said if you have an opportunity to save a life, you have to take it.

As a result, Mr. Early said he would like to see Worcester's police and firefighters properly trained to administer and carry Narcan.

"You've got a pulse. You've got a breath. That's no time for debate," Mr. Early said. "That's time to get that Narcan spray out from a certified trainer, use it, save that life, then deal with the problem of addiction."

Worcester Police Chief Gary J. Gemme said the Police Department is in the preliminary stages of evaluating whether equipping officers with Narcan is a possibility.

"This is a life-saving tool and I am open to looking at the possibility of equipping our officers with Narcan kits," Chief Gemme said. "However, I would like to do more research on the topic."

In 2013, there were 328 overdose calls in the city of Worcester, with eight confirmed overdose deaths for the first half of last year. However, cases are still pending the medical examiner's final ruling from the latter part of 2013, Chief Gemme said.

This year, there have been 46 overdose calls in Worcester, he said.

Chief Gemme said he does not believe there has been a sharp spike in fatal opiate overdoses this year.

Fitchburg Police Chief Robert A. DeMoura said equipping police and fire departments across the state with Narcan makes sense.

"I would think, as a first responder, there is no doubt that Narcan plays directly into our role as police to utilize this product," Chief DeMoura said.

Chief DeMoura said the Fitchburg Police and Fire departments are in the process of seeing how they can train and equip their police officers and firefighters with Narcan.

"We should have Narcan and there's no downside. And we should have it as soon as possible."

Southbridge Police Chief Daniel R. Charette said he thinks trained ambulance personnel should have Narcan, but doesn't know if police have the necessary medical background to use it.

"If you work from the basic premise that a drug addiction is a medical issue, first and foremost, you'll actually get better results," Chief Charette said. "And, to me, we're talking about someone who is in the midst of a medical emergency and, from what I know about Narcan, it helps with the medical perspective of that. It helps revive the person. And I certainly have no problem with any of that. I think it makes sense."

Chief Charette said there have been no talks about implementing Narcan in Southbridge, but he welcomes the discussion.

"This strikes me a lot like the old argument about needles or no needles. Do you end up with a hepatitis C epidemic because you don't provide needles and addicts are sharing them, or do you provide needles and try to do the proper thing that the health authorities are telling you?" Chief Charette said. "I think, all times, we should look at the professionals in a particular field and listen to what they have to say."

Community activist William T. Breault, chairman of the Main South Alliance for Public Safety in Worcester, said he supports emergency first-responders being properly trained and carrying Narcan, but he is against giving it away to drug abusers and their friends.

"We support paraprofessionals, EMS, police and fire doing it, but we don't think you should enable people out there that Narcan is the silver bullet," Mr. Breault said. "It shouldn't be given out to everybody."